| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | UNITED HEALTHCARE INSURANCE COMPANY | $7K | — | $7K | 5.00% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS SVCS, INC | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | UNITED HEALTHCARE INSURANCE COMPANY | $3K | — | $3K | 2.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | HUMANA INSURANCE COMPANY | $3K | — | $3K | 5.01% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 5330 CARROLL CANYON RD, STE 110 SAN DIEGO, CA 92121 | HUMANA INSURANCE COMPANY | $3K | — | $3K | 4.25% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 100 OTTAWA AVENUE SW GRAND RAPIDS, MI 49503 | UNITED HEALTHCARE OF CALIFORNIA | $3K | — | $3K | 5.00% |
| ACRISURE LLC3 Filed as: ACRISURE OF CALIFORNIA LLC | 3827 MEGAN LANE OLIVEHAIN, CA 92007 | HARTFORD LIFE AND ACCIDENT | $3K | — | $3K | 11.50% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 138 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 138 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 28 | $192K |
| Dental | HUMANA INSURANCE COMPANY | 136 | $64K |
| Vision | HUMANA INSURANCE COMPANY | 136 | $64K |
| Life insurance | HUMANA INSURANCE COMPANY | 136 | $64K |
| Long-term disability | HARTFORD LIFE AND ACCIDENT | 137 | $27K |
| Prescription drug(2 contracts, 2 carriers) | UNITED HEALTHCARE INSURANCE COMPANY | 28 | $192K |
| Other | HUMANA INSURANCE COMPANY | 136 | $64K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 137 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.